Minnesota Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Minnesota Comprehensive Health Association / MCHA
Insurance Regulation Establishing Risk Pool
Minnesota Legislature
Chapter 317, Revised in 2005 under ;Chapter 62E
Minnesota Comprehensive Health Association (MCHA)
MCHA was established in 1976 by the Minnesota Legislature to provide health coverage to Minnesota residents who have been denied health insurance by the private market, due to pre-existing health conditions.
To be eligible for the coverage, individuals must have exhausted their COBRA benefits; individuals must be working for employers who do not offer health insurance; individuals must have exceeded lifetime maximum limits, or their previous coverage and former employees of bankrupt companies.
Funding
The program is funded through member premiums and an annual assessment on all health plans. In 2005, about 30,000 Minnesota residents are insured by MCHA throughout the state. Assessment of insurance carriers with no tax offset. Licensed carriers are assessed according to the volume of business the conduct in the state and are offset against premium taxes.
Plans Offered
MCHA offers seven different individual health plans. Five of the plans are PPO plans with varying deductible amounts. The other two plans are High Deductible Health Plan and Basic Medicare Supplement Plan.
Plan Benefits
The five PPO plans offering the same level of coverage with different deductible options of $500, $1,000, $2,000, $5,000 and $10,000. Once the plan deductible has been met, you pay a coinsurance of 20% for most covered medical benefits when using an in-network provider. Your maximum annual coinsurance limit is $3,000, except on the $5,000 and $10,000 deductible plan in which the deductible is your out-of-pocket maximum.
The High Deductible Health Plan meets federal requirements for Health Savings Accounts. Once you have met the annual deductible, you are covered at 100% for covered medical expenses.
The Medicare Supplemental plan is a Basic Medicare Supplemental plan in which MCHA will pay the 20% coinsurance for Medicare after you have met the Medicare deductibles.
Maximum Benefit Limits
MCHA PPO health plans offer a lifetime maximum benefit of $5,000,000.
Eligibility
- You have been a resident of Minnesota for at least 6 months immediately preceding your application submittal date
- You must have elected and exhausted health benefits through COBRA or a similar State of Federal continuation plan;
- You have had 18 months of continuous coverage under a health plan with the most recent coverage being an employer sponsored, church or government plan and had no more than a 63 day break in coverage;
- Your prior coverage must not have been subject to termination of COBRA coverage because you failed to pay the premium or because you committed acts of fraud; and
- You cannot be eligible for Medicare or Medicaid, and must not have other health insurance coverage (as a dependent or otherwise).
- You have, within the past 6 months, been denied medical insurance coverage from a Minnesota insurance company or licensed insurance agent
- Or, you are over age 65 at not eligible for Medicare benefits
- Or, you are under the age of 65 and eligible for guaranteed issue coverage under federal HIPAA regulations
- Are eligible under Trade Adjustment Assistance or Pension Benefit Guaranty Corporation
- You have been treated in the past three years for one of the "presumptive" medical conditions listed under the MCHA eligibility guidelines
Enrollment Periods
MCHA is open to enrollment at all times. To be eligible under cover through federal HIPAA regulations, you must apply for coverage within 63 days of the termination date of your previous group health plan or COBRA expiration date.
Premium Payments
MCHA premiums are based on your age, your gender, your MCHA plan selection and your history of tobacco use.
Premium Calculations
MCHA premiums are authorized by the insurance commission and must fall between 101% and 125% of the standard risk rate available to residents of Minnesota that are covered under individual health insurance of similar benefit levels.
Pre-Existing Condition Waiting Periods
For all MCHA policies, no benefits are payable during the first six months of coverage for expenses for any preexisting condition, injury, illness or other physical or mental condition that was diagnosed, treated or evaluated during the 90 days prior to the effective date of coverage. Some exceptions apply to the preexisting condition limitation. In order to determine if your eligibility for a waiver, you must request a waiver of the preexisting condition limitation by completing waiver request section of the MCHA application.
Minnesota Comprehensive Health Association Contact Information
Minnesota Comprehensive Health Association
Customer Service, Mail Route CP555
401 Carlson Parkway
Minnetonka, MN 55305-5387
Phone: 866-894-8053
MCHA Website
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